Study established more than 3,200 daycares in Bangladesh; findings suggest further scaling up

Establishing home-based community-led daycare centers in rural Bangladesh was effective in reducing the number of drowning deaths among children 9 to 47 months old by 88 percent, according to a study led by researchers at the Johns Hopkins International Injury Research Unit. 

The study, published online May 11, 2020 in Injury Epidemiology, also uncovered the extent to which drownings burden the country, especially among children. Drowning accounts for 42 percent of all deaths among children aged 1 to 4 years old in Bangladesh.

“This study shows how drowning causes a terribly high burden of childhood deaths in Bangladesh. About two children between the ages of 1 and 4 die every hour from drowning in Bangladesh,” says study lead author Olakunle Alonge, MD, assistant professor in the Department of International Health at the Bloomberg School. “Fortunately, community-based daycares can be highly effective at reducing drowning risk.”

According to the World Health Organization, drowning is the second leading cause of injury-related deaths among children aged 1-19 years old worldwide and more than 322,000 people die from drowning each year. More than 90% of these drowning deaths occur in low- and middle-income countries. The World Health Organization also estimates that Bangladesh has one of the highest drowning rates in the world for children under five years old.

The Bloomberg Philanthropies Initiative to Prevent Drowning supports drowning prevention activities in Bangladesh including supervision of young children in daycare. Bloomberg Philanthropies funded Johns Hopkins Bloomberg School of Public Health to implement this study evaluating drowning prevention interventions.

For the study, more than 3,200 new daycare sites, known as crèches, in seven rural sub-districts of Bangladesh were established, with over 64,000 children 9 to 47 months old enrolled in the daycares. Private homes of select community members were identified as crèche sites, which operated six days a week from 9am – 1pm at no charge to the families. Each daycare was supervised by two trained workers and provided early childhood curriculum, meals, and basic hygiene education.

The researchers compared baseline drowning deaths in these areas through a retrospective analysis covering July 2012 to November 2013 to drowning deaths that occurred after the daycares had been established from October 2013 to February 2016. The results highlight that drowning deaths reduced by 88 percent among daycare-enrolled children aged 1 to 4 years old, leading the authors to recommend this intervention be introduced and scaled up in Bangladesh and other rural low- and middle-income country settings.

“With crèches contributing to such a positive impact in select communities, we’re working hard to further develop, sustain, and scale up the interventions and expand their lifesaving reach in the region,” says Abdulgafoor M. Bachani, PhD, associate professor in the Bloomberg School’s Department of International Health, and director of the Johns Hopkins International Injury Research Unit.

Among children younger than 11 months, the study found that drowning rates were significantly higher following the intervention. The authors note that this could be due to an underestimation in the baseline rates, potentially due to information and recall bias, and that children had to be at least 9 months old to be enrolled in daycare, so many children in the under 11 month age group were not affected by the daycare intervention.

Bloomberg Philanthropies has continued funding community daycare in Bangladesh for more than 50,000 children since the study ended in 2016. The daycares are currently closed due to the pandemic, and teachers are conducting daily house visits for the enrolled children to check on their health and provide the families with information about SARS-CoV-2.

“Large-scale evaluation of interventions designed to reduce childhood drownings in rural Bangladesh: a before and after cohort study” was written by Olakunle Alonge, David Bishai, Shirin Wadhwaniya, Priyanka Agrawal, Amin Rahman, Emdad Md. Dewan Hoque, Kamran Baset, Shumona Sharmin Salam, Al-Amin Bhuiyan, Md Irteja Islam, Adul Talab, Qazi Sadeq-ur Rahman, Fazlur Rahman, Shams El-Arifeen, and Adnan A. Hyder.

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